A novel use of a clinical assessment system to assistemergency teams to support the frail and vulnerable            elderl...
   Describe the system     interRAI How it is used today in New Zealand How interRAI information was used  post earthq...
interRAI - clinical assessment and care                       planning methodology   interRAI (www.interRAI.org) is a not...
Single assessment framework – many areas of    health careAt least 80% of items common across the suite:   Contact Assess...
If you are going to assess somebody make sureyou cover at least these domains...
...and enquire further for each domainaround specific items....and code consistently
interRAI outputs – CAPs, outcomes, qualityindicators
2002 Health of Older People StrategyGap between current and best practiceNeed Evidence based approachAssessment Process fo...
National interRAI platform business model „today‟DHBs contracted           Ministry of Health      Residential care to imp...
The national interRAI platform technical model „today‟                  Assessor                                          ...
At risk population (s) post earthquake   Frail elderly...     Frailtyencompasses many dimensions including but      not ...
interRAI fellows - on the ground in NZ           (and in Canada)   Brigette Meehan, PhD – in charge of national    interR...
An email timelineFeb 21/11 9:15 pm (Hirdes)“Just saw the footage of the      Feb 22/11 1:33 am (Millar)terrible earthquak...
email timeline (cont‟d)Feb 22/11 7:05 am (Hirdes)         Feb 22/11 6:18 pm“if the RAI-HC is fully rolled    Hirdes send...
Initial NZ Earthquake Algorithm (Principles)           (Source: Back of Napkin)   Identify those with immediate (emergent...
The risk profile          (Source: Back of Napkin)       Lives alone, no primary helper, any signs of caregiver        di...
Clinical prioritisation (Source: Back of Napkin)   Many items common across most clients, the data was    grouped based o...
email timeline (cont‟d)Feb 22/11 8:56 pm (Mor)“Add diabetes and ver[y] advanced age. Great idea. I suggested thisfor Katr...
Supporting evacuations out of CanterburyinterRAI Assessments also Used to Manage Transfer of                 300 Seniors o...
Acknowledgements   Dr Nigel Millar - Chief Medical Officer of Canterbury DHB and interRAI    fellow for New Zealand.   P...
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A Novel Use of a Clinical System to Assist Emergency Teams to Support the Frail and Vulnerable Elderly after the Canterbury Earthquake

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Andrew Downes
HIQ Ltd New Zealand & Canterbury District Health Board
(Thursday, 2.30, Innovation in Practice 1)

In the days and weeks after the Canterbury earthquake, emergency response teams needed to be able to identify and support people who were at risk of adverse outcomes from a health perspective.
These people were not acutely injured during the earthquake itself. They were a potentially sizeable population of frail elderly living in the community in their own homes. They often have multiple co-morbidities and due to their low resilience could have ‘tipped over’ into needing acute care services very rapidly.
The implementation of interRAI, a national assessment tool being used by all District Health Boards allowed Canterbury DHB to receive prioritised lists from the national interRAI data warehouse, of ‘at risk’ elderly to assist the response teams to target their services.
In addition, subsequent to the earthquake a number of elderly people were moved from their homes and residential care facilities to other parts of the country. The national interRAI system was able to seamlessly move assessment and care plan records to the receiving District Health Board so that the receiving services could continue care appropriately.

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A Novel Use of a Clinical System to Assist Emergency Teams to Support the Frail and Vulnerable Elderly after the Canterbury Earthquake

  1. 1. A novel use of a clinical assessment system to assistemergency teams to support the frail and vulnerable elderly after the Canterbury earthquake Health Informatics New Zealand 23rd November 2011 1
  2. 2.  Describe the system  interRAI How it is used today in New Zealand How interRAI information was used post earthquake
  3. 3. interRAI - clinical assessment and care planning methodology interRAI (www.interRAI.org) is a not for profit collaborative network of 60 researchers and health/social service professionals in over 30 countries Their goal is to promote evidence-based clinical practice and policy decisions through the collection and interpretation of high quality data about the characteristics and outcomes of persons served across a variety of health and social services settings.
  4. 4. Single assessment framework – many areas of health careAt least 80% of items common across the suite: Contact Assessment (screener assessment) Home Care Long Term Care Facility Assisted Living Acute Care Post Acute Care Mental Health Care Community Mental Health Palliative Care Quality of life
  5. 5. If you are going to assess somebody make sureyou cover at least these domains...
  6. 6. ...and enquire further for each domainaround specific items....and code consistently
  7. 7. interRAI outputs – CAPs, outcomes, qualityindicators
  8. 8. 2002 Health of Older People StrategyGap between current and best practiceNeed Evidence based approachAssessment Process for Older People (2003) NZGG
  9. 9. National interRAI platform business model „today‟DHBs contracted Ministry of Health Residential care to implement interRAI ‘SaaS ‘SaaSContract’ Contract’ Service Management Single national contract SLA (DHBs)
  10. 10. The national interRAI platform technical model „today‟ Assessor Connected health networksNational Health Index Internet External cliniical PAS systems Single host National Northern/Southern regions PROD Central/Midland regions PROD TRAINING data warehouse TEST/Wiki/data warehouse
  11. 11. At risk population (s) post earthquake Frail elderly...  Frailtyencompasses many dimensions including but not limited to; functional capability, physiological reserve, cognitive performance, disease progression and disease instability. .....who are also vulnerable  Vulnerability encompasses dimensions such as whether someone lives alone, the strength of their support networks both formal and informal, loneliness and the persons cognitive performance (especially in relation to decision making).
  12. 12. interRAI fellows - on the ground in NZ (and in Canada) Brigette Meehan, PhD – in charge of national interRAI Implementation Nigel Millar, MD – Chief Medical Officer, Canterbury District Health Board Vincent Mor, PhD – Visiting Professor from Brown University, on sabbatical in NZ Professor John Hirdes - Chair, Department of Health Studies and Gerontology, University of Waterloo
  13. 13. An email timelineFeb 21/11 9:15 pm (Hirdes)“Just saw the footage of the Feb 22/11 1:33 am (Millar)terrible earthquake in “Jan and I plus family ok - but itsChristchurch. I hope you guys are not good here.”ok.” Feb 22/11 2:09 am (Mor)Feb 21/11 10:10 pm (Meehan) “Take care of yourself and good“I havent heard from Nigel, but luck as you struggle to help your cityexpect he will be very busy given and its people recover.”his role. My family are all ok butquite distressed.” Feb 22/11 4:30 am (Millar) “Sorry to miss you …Feb 22/11 1:20 am (Mor) Planning an interRAI earthquake“we are fine; not in assessment.”Christchurch yet so Im not going.Ive not heard from Nigel but willsoon.” @interRAI_Hirdes Twitter:
  14. 14. email timeline (cont‟d)Feb 22/11 7:05 am (Hirdes) Feb 22/11 6:18 pm“if the RAI-HC is fully rolled Hirdes sends draft algorithmout in Christchurch and you are code to NZ groupable to obtain person-leveloutputs, you should be able toget a list of vulnerable seniorswho may be in need of extrahelp at this point”.Feb 22/11 5:20 pm (Meehan)“great idea … [it] will behelpful Im sure. I have spokento Andrew [our] softwaremanager and he is going to pulldata this morning to send toCanterbury.” Twitter: @interRAI_Hirdes
  15. 15. Initial NZ Earthquake Algorithm (Principles) (Source: Back of Napkin) Identify those with immediate (emergent) risk with limited caregiver support a) Isolated or distressed caregiver b) Vulnerable (and frail) Twitter: @interRAI_Hirdes
  16. 16. The risk profile (Source: Back of Napkin) Lives alone, no primary helper, any signs of caregiver distress, poor vision, difficulty with meal preparation, difficulty with managing medications Had Cognitive Performance Score (CPS) of >2.  the CPS score is an interRAI outcome measure scored from 1-6 where 1= no cognitive impairment and 3-6 = moderate to severe cognitive impairment. Elements that make up the CPS score include decision making ability, memory loss, ability to make self understood and ability to manage eating. A score of >2 indicates early onset of cognitive issues eg memory loss. Had CHESS score > 2  the CHESS score is an interRAI ‘frailty/stability’ measure scored 1-5 where 1= person is stable and 5= highly unstable. Elements that make up the CHESS score include presence of vomiting, oedema, shortness of breath, weight loss, decrease in food or fluid, insufficient fluid intake, decline in ADLs, decline in decision making and any end stage disease. Had ADL score >2  The ADL score is scored from 1 – 6 where 1= no problems with ADL and 6 = fully dependent in washing and dressing, toileting , eating and locomotion.
  17. 17. Clinical prioritisation (Source: Back of Napkin) Many items common across most clients, the data was grouped based on the outcome scores to support quicker prioritisation Group 1 (most likely highest priority)  all those WHERE CPS > 2 AND CHESS >2 AND ADL >2 – approximately 100 people Group 2 (most likely next priority)  all those WHERE score >2 in ANY two of: CPS OR ADL OR CHESS - approximately 250 people Group 3 (most likely next priority)  All those WHERE score >2 in ANY one of: CPS OR ADL OR CHESS – approximately 400 people
  18. 18. email timeline (cont‟d)Feb 22/11 8:56 pm (Mor)“Add diabetes and ver[y] advanced age. Great idea. I suggested thisfor Katrina but no one listened”Feb 23/11 3:26 am (Downes)“Nigel & the Canterbury response teams have now had a copy ofthe list of vulnerable seniors.What a great international effort and onebased on real life up to date accurate person level data” Within 24 hours a great set of data for use Twitter: @interRAI_Hirdes
  19. 19. Supporting evacuations out of CanterburyinterRAI Assessments also Used to Manage Transfer of 300 Seniors out of Earthquake ZoneTwitter: @interRAI_Hirdes
  20. 20. Acknowledgements Dr Nigel Millar - Chief Medical Officer of Canterbury DHB and interRAI fellow for New Zealand. Professor Vince Mor - Chair of the Department of Community Health at the Brown University School of Medicine, Providence, Rhode Island and interRAI fellow. Professor John Hirdes - Professor and Ontario Home Care Research and Knowledge Exchange Chair, Department of Health Studies and Gerontology, University of Waterloo & Scientific Director, Homewood Research Institute and interRAI fellow. (For use of some slides also) Stella Ward - Executive Director Allied Health Canterbury DHB & West Coast DHB Rebecca Rippon – information analyst at Capital and Coast District Health Board. Rebecca completed the data extraction and analysis for Canterbury DHB Doug Braun – Database administrator at Momentum Healthware Inc for additional technical support and assistance with data extraction. The interRAI lead practitioners and system clinicians that supported the transfer process.

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